Fact-Checking the Egregious WaPo PrEP Op-Ed

1/29/2016

Today the Washington Post published what has to be the most egregiously erroneous piece ever written for a major publication, or even a minor one, about Truvada as pre-exposure prophylaxis (PrEP) against HIV. I wrote an email to the paper's public editor, Erik Wemple, pointing out the following litany of errors in the article, which is entitled "The miracle AIDS drug that people refuse to take." (Even the title itself contains two factual errors.)

Dear Erik,

You and I have corresponded about errors in WaPo’s HIV reporting in the past. To remind you, I am the science reporter at POZ magazine, a publication for people living with HIV. This particular article is littered with so many egregious errors and misunderstandings I would say it should be retracted entirely.

In order, the errors are:

Truvada is an HIV drug, not an AIDS drug.
Slow uptake of Truvada is not a function of people refusing to take it, rather of lack of awareness, difficulty accessing it, or not thinking they are at high enough risk to need it.
Gay men didn’t really rejoice the 2012 approval of PrEP; most of them didn’t hear about it at all until the press started focusing on it in the fall of 2013.
Truvada is not like a vaccine, because vaccines don’t have to be taken daily. It is pre-exposure prophylaxis—a form of ongoing prevention that requires adherence to a regimen.
The Slate remark about PrEP being a miracle drug was made in 2014; the paragraph concerns things going on in 2012. Furthermore, the Slate author is no authority on HIV. His articles are littered with errors, especially his writing on PrEP. He is also, as you can see, prone to hyperbole.
Obama’s AIDS-free generation vision pre-dates the excitement about PrEP. When his administration started using the expression, in December 2013, they were focusing on Africa, not here. Until recently, PrEP was only approved in the United States.
It is not true that few people are using Truvada as PrEP. I just returned from a reporting trip to San Francisco, where men are using it in droves. Perhaps as many as 15 to 20 percent of at-risk gay men are on it. I’ve detailed how PrEP use is on a dramatic upswing in the U.S. in this article. Some rough estimates say that as many as 50,000 people are now on PrEP. I can tell you anecdotally that men in New York City are also using it at rising rates.
The author neglects to note that between 2009 and 2014 HIV diagnosis rates leveled off among men who have sex with men (MSM) as a whole, including young MSM and black MSM (they have long been dropping among whites).
A six percent rise in infections over 10 years does not constitute a “jump”.
The estimate about six in 10 blacks becoming positive by 40 was about Atlanta men who have sex with men, not the whole country.
The CDC only has one year of CDC diagnosis figures that reflect a year, 2014, when many people were using Truvada. So we cannot make any real conclusions yet about how it has affected HIV rates.
Doctors are not worried about a mega-crisis. On the contrary, many are very excited that PrEP will help turn the tide against HIV transmissions in the U.S.
Sex in 2016 is indeed safer than in the 80s if someone is on PrEP.
To say that the fight against HIV is an either/or between fighting stigma an promoting PrEP is completely off the mark. I actually don’t know what he’s referring to here. And he says these campaigns come from doctors. Such campaigns typically come from health departments or community-based organizations.
The writer completely misunderstands Truvada’s 2004 approval. It approved as HIV treatment at that time. PEP is something separate—it involves taking a triple cocktail of HIV drugs for 28 days within 72 hours of an HIV exposure to prevent infection. There are only two drugs in Truvada, not three.
No, PEP did not just magically become PrEP with a “couple tweaks.” This is complete nonsense. A rigorous, massive, global clinical trials process proved PrEP’s efficacy in 2010. There have been numerous other clinical trials since then.
“Unprotected sex” is no longer specific enough of a term in the age of PrEP. “Condomless intercourse” is the preferred term.
The 57 percent figure is not nationally representative. It is a poll of men recruited at gay venues in about 20 major urban areas that the CDC conducts ever three years (it just released its most recent edition). It is also not representative of urban areas.
That 21,000 figure is only a rough estimate. And it reflects where prescriptions likely were a year ago.
The writer focuses on older studies of Truvada for his information about adherence to the daily regimen. More recent studies, and ones that are more reflective of real-world use, including the PROUD study in the UK, as well as a paper about a large San Francisco PrEP program, have found high levels of adherence.
The whole “Truvada whore” thing is really fading.
An 11 percent rate of people trying Truvada would actually be quite good, especially if those people are at higher risk of HIV than the others. There is evidence that men who are at higher risk are more inclined to take PrEP and more inclined to adhere to the regimen.
Doctors’ awareness about and willingness to prescribe PrEP is increasing.
Again, HIV rates are leveling off among gay men. They are still rising among Latino gay men, though.

To read more about PrEP and to look for sources for certain facts, I invite you to visit the PrEP page on my web site: www.benryan.net/prep.

Sincerely,

Benjamin Ryan
Editor at Large
POZ magazine

25 Comments

SisterUnity

1/30/2016 02:16:27 am

Bravo, and thank you!

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Chip Eakins The Philadelphia Center link

1/30/2016 07:42:03 am

Thank you Benjamin! I appreciate your ongoing efforts to call out irresponsible, and erroneous information on HIV issues. I just started PrEP and blogging about the experience.

serbkoala link

1/30/2016 11:34:46 am

Dear Ben,

I appreciate you taking the time to 'fact check' the Washington Post article. However I will now 'fact check' your 'fact check' and ask you what is your real purpose of not properly 'fact checking' the article was, as much or you 'fact-checking' was 'opinion-checking.'

Further, you should probably realise the purpose of the WP article outlined by the last sentence of the piece, stating 'it’s time to make knowledge infectious. It has side effects we can live with.' This is the WP not the The Journal of Infectious Diseases.

In order, your fact-checking errors (and few successes) are:
- Truvada is an HIV drug, not an AIDS drug (this is neither true nor false - if someone had HIV they may take Truvada, if they had been diagnosed later on and reached the staged of AIDS they may still take Truvada).

Slow uptake of Truvada is not a function of people refusing to take it, rather of lack of awareness, difficulty accessing it, or not thinking they are at high enough risk to need it. (Where are your facts to back up the difference between people's behavior in intention to take Truvada, perhaps cite some peer-reviewed articles from The Journal of Infectious Diseases to legitimize this 'fact').

Gay men didn’t really rejoice the 2012 approval of PrEP; most of them didn’t hear about it at all until the press started focusing on it in the fall of 2013. (Again, reference a peer-reviewed social science behavioral journal to substantiate this fact).

Truvada is not like a vaccine, because vaccines don’t have to be taken daily. It is pre-exposure prophylaxis—a form of ongoing prevention that requires adherence to a regimen. (This is true. However, referred to something as 'like' something else is a metaphor. A metaphor is used to make comparisons or elucidate concepts, not to say something 'is' something else (this is a simile).

The Slate remark about PrEP being a miracle drug was made in 2014; the paragraph concerns things going on in 2012. (True).

Furthermore, the Slate author is no authority on HIV. His articles are littered with errors, especially his writing on PrEP. He is also, as you can see, prone to hyperbole. (Again, 'define who is your authority on HIV' and provide substance to support this instead of making sweeping generalizations).

It is not true that few people are using Truvada as PrEP. I just returned from a reporting trip to San Francisco, where men are using it in droves. Perhaps as many as 15 to 20 percent of at-risk gay men are on it. I’ve detailed how PrEP use is on a dramatic upswing in the U.S. in this article. Some rough estimates say that as many as 50,000 people are now on PrEP. I can tell you anecdotally that men in New York City are also using it at rising rates. (Again, what is your definition of 'few'. You might want to check out Dr Bob Grant's peer-reviewed articles and note he is a leading researcher on the iPrEx Study Team. He has noted there is obviously more people taking Truvada in San Fran but numbers are below 15% - this may be considered 'few'. Further, peer-reviewed research is considered more credible than 'anecdotal evidence' unless you can say you met a mixed sample study to represent gay men in New York).

The author neglects to note that between 2009 and 2014 HIV diagnosis rates leveled off among men who have sex with men (MSM) as a whole, including young MSM and black MSM (they have long been dropping among whites). (Failure to admit is not an error in 'fact' as no 'fact' can be disputed rendering it impossible to be wrong about something if you haven't clearly stated it).

A six percent rise in infections over 10 years does not constitute a “jump”. (Again, find a peer-reviewed and scientific benchmark or legal definition of what is or isn't considered a 'jump.')

Doctors are not worried about a mega-crisis. On the contrary, many are very excited that PrEP will help turn the tide against HIV transmissions in the U.S. (Again, name some doctor's otherwise you can't make sweeping generalizations such as 'many are excited' ...how many would that be; two or two thousand?)

To say that the fight against HIV is an either/or between fighting stigma an promoting PrEP is completely off the mark. I actually don’t know what he’s referring to here. And he says these campaigns come from doctors. Such campaigns typically come from health departments or community-based organizations. (If you don't know what he is referring to how can you dispute it? Further, last time I checked health departments were made up of doctors).

The writer completely misunderstands Truvada’s 2004 approval. It approved as HIV treatment at that time. PEP is something separate—it involves taking a triple cocktail of HIV drugs for 28 days within 72 hours of an HIV exposure to prevent infection. There are only two drugs in Truvada, not three. (Congrats, this is the first correct fact check and error).

No, PEP did not just magi

Ben Ryan

1/30/2016 02:38:55 pm

Who are you, anyhow? Are you the author of the piece?

Roger Kloress

1/30/2016 06:03:48 pm

If, as you suggest, somewhere near 15% of SF HIV-negative MSM are on PrEP... Since the CDC estimates that perhaps 25% of MSM are at sufficient risk to be advised to do PrEP... That means that 60% of those who should be taking it in SF are taking it. Damn good number.

serbkoala

1/30/2016 03:24:27 pm

No, I am not the author.

I am just stating if you want to 'fact check' an article you need to separate it from blending a fact into an opinion checking expedition.

You can ignore my feedback or take it on board, i'm just trying to be objective. The fact you quoted it as being the most ''egregiously erroneous piece ever published about PrEP' would need to be 'fact checked' on that opinion/comment if we are being fair.

You obviously don't realise the struggles people in other countries even have to afford PrEP. Australia will soon join the USA to be the second country where it will be readily available to be prescribed and affordable through government subsidy, and it's been some fight to get that far.

The article's sentiment is to encourage PrEP use and not be afraid of it, and as someone who can readily access to PrEP, being in the USA, be grateful, as others don't even have that opportunity and are every day becoming another HIV/AIDS statistic.

Dean Ramos

1/30/2016 06:10:09 pm

I agree with Serbkoala, the point of the article is clear. It's to make apparent the disparity the efforts of LGBT groups to endorse prevention of HIV rather than putting all emphasis on taking the stigma out of HIV. Because the death sentence is no longer there, many people don't take HIV prevention seriously enough. We lost an entire generation of young gay men. People wasted away to nothing. If we taught more young men about that time, they would think twice in taking the steps to actively protect themselves.

Additionally, Ben. You mention that Prep use is growing among MSM, but for many men of color (who have the highest rates of infection), the price tag and lack of available resources takes away that option from the people who need it the most. Atlanta should be a canary in the coal mine for the gay community, however their has been utter silence from gay activist groups in tackling the health crisis already happening there and the possibility of spreading infections to adjacent cities and towns.

Just as well, reading your article, I see that your analysis of the WP article prone to unnecessary and dramatic knit picking, sweeping generalizations, and anecdotal evidence: not much of a compelling argument.

Todd

1/31/2016 04:12:16 am

I can't for the life of me understand the opposition to Truvada in the gay community, and I can't see your "fact-checking" as anything other than petty nitpicking in an attempt to discredit the article in favor of whatever your true agenda is. The more cynical side of me says that if we no longer have a climbing rate of infection, you'll have fewer readers for your magazine. Hopefully that's not the case.

The original article may have had issues, but the overall premise can't be disputed: HIV infections are on the rise (in some areas) despite the fact that there is an effective method of prevention and many gay health organizations are either ineffective at promoting its use or are actively working to ensure it isn't adopted.

Roger Klorese

1/31/2016 04:48:59 am

I don't understand how you read the original article as being in support of PrEP. To me - and, i believe, to Ben Ryan - it reads like an AHF-friendly "it's a failure, nobody wants it" screed. That is why these corrections are needed. (Plus the hysterical 1990s use of "AIDS" is overblown, and implies that without a late-stage HIV disease diagnosis, one would not take Truvada.)

SkippyJon

1/31/2016 06:11:46 am

Exactly what I was thinking.

Ben Ryan

1/31/2016 09:25:46 am

I actually couldn't figure out what the WaPo's article's overall thesis was. But he seemed intent on lambasting PrEP in general. The bottom line for me, though, is that he got so many of his facts wrong his piece never should have appeared in print.

Charles

1/31/2016 01:03:20 pm

"Egregious errors" suggests that harm has been done. Are you implying the author's main assertion that more gay men need to be on PrEP is a harmful one?

Ben Ryan

1/31/2016 02:20:57 pm

I frankly can't tell what the author is arguing.

Ben Ryan

1/31/2016 02:25:50 pm

Furthermore "egregious" does not necessarily imply harm has been done, as you state. The word is defined as such: "extraordinary in some bad way; glaring; flagrant." But it is indeed harmful to spread misinformation about public health, especially when it might affect people's decisions about how to protect themselves against disease, might stigmatize a group of people, or cause unnecessary anxiety.

Charles

1/31/2016 03:41:28 pm

You wrote a critique on an article you don't even understand. That's laughable.

Ben Ryan

1/31/2016 05:45:08 pm

I illustrated a litany of errors in an article that was utterly lacking in a coherent focus or overall thesis.

Lewie

1/31/2016 02:19:04 pm

I am black gay guy living in ATL on PrEP. I know many men on Truvada but I can attest that one of the biggest hurdles to obtaining treatment is our Republican governor Nathan Deal callously denied our state the Medicaid expansion in the Affordable Care Act. This would have allowed 600,000 low-income Georgians access to life-saving medical care, including the doctor visits required to obtain the blood panels and testing for a Truvada prescription. He, like many other Republican governors have placed politics over people. Shame on Gov. Deal!

Ben Ryan

1/31/2016 02:21:37 pm

Amen. Ten out of the 19 states that have not expanded Medicaid are in the South.

Peter Godtree

1/31/2016 05:20:36 pm

This attempt to cast aspersion on Truvada is a deliberate lie by whoever the fuck the writer of this article is. Truvada was first approved for treatment in 2004 but not for PrEP until 2012. However, the number of Negs who take Truvada is extremely low.
Gay men walked away from so called Safe Sex ever since the advent of protease inhibitors in 1998. This is the primary reason most chapters of ACT UP went defunct in 1999, not because of the demon drug Truvada but because people had had enough of the slut shaming & hysteria.
Real HIV & STD statistics show most transmissions are among IV drug abusers & heterosexuals, which means the statistics being cited by anti-Truvada propaganda funded by AIDS Healthcare Foundation are a deliberate lie.

Ben Ryan

1/31/2016 05:49:54 pm

The number of people on PrEP is rising rapidly. As I wrote in this article ( http://www.poz.com/articles/PrEP_2_401_28095.shtml):

Data from Gilead Sciences, which manufactures Truvada, suggest that U.S. PrEP prescriptions more than tripled between 2014 and 2015, with MSM the apparent primary adopters of an HIV prevention method that the U.S. Food and Drug Administration (FDA) approved in July 2012. New York State Medicaid data have indicated a more than four-fold upswing in PrEP prescriptions during that period, from 303 to 1,330. And a study that surveyed MSM attendants of the Seattle Pride Parade found that the proportion of those at high risk for HIV who reported ever taking PrEP increased from 5 percent in 2012 to 31 percent in 2015, with 23 percent of the overall group currently on Truvada.

A very rough, and likely low-ball, estimate suggests that about 22,000 Americans were on PrEP at the beginning of 2015, including perhaps 4,000 in San Francisco.

Additionally, your statement about the current demographics of HIV transmissions is also incorrect. About two thirds of new HIV cases are among men who have sex with men. You can read more about the current state of the epidemic here: http://www.poz.com/articles/state_HIV_epidemic_401_28256.shtml

And here is an article about the CDC's most recent report on changes in diagnosis rates: http://www.poz.com/articles/slowing_epidemic_761_28154.shtml

Peter Godtree

2/2/2016 07:43:29 am

1st, CDC reported numbers don't match state reported numbers, and CDC reported numbers only go up to 2013 whereas state reported numbers are available for 2014 & 2015. The CDC graph you cited erroneously reports 2014 but is in fact based upon 2013 numbers available in 2014, and not actual 2014 numbers, because CDC hasn’t gotten around to cooking the numbers for 2014 yet. In any case, both sets of numbers show a steady decline in new infections among MSMs over the years, contrary to the claims made by the WaPo article.
2nd, I’m of the opinion the rate of new transmissions among MSMs has fallen below 50% in most states in the last year, whereas a surge is been taking place among IDUs etal due to increasingly hostile surveillance & treatment by healthcare providers & public officials which in return causes aversion to reporting, testing & adherence to treatment, which in turn causes increasing susceptibility to transmission due to rising numbers of IDUs etal living with HIV. What's more, CDC estimates 40 to 85% of IDUs etal living with HIV are unaware until late in the prognosis for untreated HIV (10 to 11 years?).
3rd, the initial surge in numbers of new infections among MSMs following the advent of protease inhibitors was due to the surge in numbers of persons living with HIV because they were no longer dying, thereby increasing the total prevalence of & susceptibility to HIV among MSMs as the cause of the surge in new HIV among MSMs as opposed to the false claim of increased sluttiness as suggested by the WaPo article.
4th, I’m of the opinion the decline in new transmissions among MSMs is due initially to the increase in non-detectible viral load status among persons living with HIV and additionally to the increasing adoption of PrEP among MSMs in recent years, despite most MSMs still not knowing what it is. This suggests the problem with PrEP isn’t any genuine aversion as suggested by the WaPo article but garden variety ignorance and no doubt the confusion caused by the disinformation campaigns waged by AIDS Healthcare Foundation and the poison pens of Michael Weinstein & his followers.
5th, but what about STDs and unwanted pregnancy? Condoms are a stop gap or an augment, but not a panacea to avoid PrEP or treatment which by itself can eliminate the risk of HIV (& HBV) infection both coming & going. Clean needle exchanges & anonymous testing are another line of constructive engagement. I would also advocate all persons jailed or institutionalized, applying for a government job or assistance, be tested anonymously for HIV & STDs, and mandatory vaccinations for a host of diseases. What’s not constructive is hostile slut or IDU shaming & hysteria

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